Amidst the current outbreak of COVID-19, community leaders nationwide are being asked to determine what services should remain available to community residents during shelter-in-place restrictions or lockdowns. Since the onset of the COVID-19 pandemic, veterinary practices have consistently been designated an essential healthcare business. However, as their work continues, employers of veterinarians and their teams must work together to develop protocols to protect the health and safety of team members and clients.

The development of such protocols requires implementing risk management strategies, including risk assessment. Curricula in AVMA-accredited programs at colleges and schools of veterinary medicine provide veterinarians with the epidemiologic skills needed to make such determinations, and veterinarians across multiple sectors of the profession perform similar risk assessments as a routine part of daily practice. Veterinary practice owners should use their risk assessment skills in developing plans to protect team and client safety, and then communicate those plans to their team members and clients.

The hierarchy below may help assess a clinic’s risk level. What works for one practice may not work for another, and the AVMA therefore encourages employers to use their best judgement when evaluating currently available information. Employers need to be prepared to reassess risk levels as new information is learned about COVID-19 and its transmission in each community.

The greatest risk of COVID-19 exposure to veterinarians, their teams, and the public comes from person-to-person contact. Staff should not come to work if sick. Interventions to reduce the risk of COVID-19 transmission are the same at a veterinary clinic/hospital as in other aspects of daily life.

What works for one practice may not work for another, and the AVMA therefore encourages employers to use their best judgement when evaluating currently available information.

Protocols specific to protecting staff when in high-risk situations (e.g. entering an infected person’s home or coming into proximity with a sick person) should be consistent with the most up-to-date guidance from state and federal public health authorities. For the most up-to-date guidance, visit your state’s department of health website and the CDC’s COVID-19 website.

Risk Level

The following risk levels are adapted from information provided by the CDC and may be helpful in developing a safety program for your team.

High Living in the same household as, being an intimate partner of, or providing care in a nonhealthcare setting (such as a home) for a person with symptomatic laboratory-confirmed COVID-19 infection without using recommended precautions for home care and home isolation

Medium Living in the same household as a person with symptomatic laboratory-confirmed COVID-19 infection while consistently using recommended precautions for home care and home isolation

Low Being in the same indoor environment (e.g., a classroom, a hospital waiting room) as a person with symptomatic laboratory-confirmed COVID-19 for a prolonged period of time but not meeting the definition of close contact (6 ft)

No Identifiable Risk Interactions with a person with symptomatic laboratory-confirmed COVID-19 infection that do not meet any of the high-, medium- or low-risk conditions above, such as walking by the person or being briefly in the same room

No Identifiable Risk Interactions with a person without symptoms in an area where community transmission of COVID-19 is occurring

Virtually No Risk Interaction with a person without symptoms in an area where cases are identified but community transmission of COVID-19 is not occurring

Virtually No Risk Interaction with a person in an area where no cases of COVID-19 have been diagnosed

Once you have assessed the risk factors for your practice location and procedures, it is imperative to communicate with your team regarding what your plan is for working with clients and patients in light of those risk factors. When formulating a plan for how you and your team will handle patients and clients, it is essential to be familiar with how COVID-19 is spread and the available methods to deal with it based on the hierarchy of controls mentioned later in this document.

Be prepared that perception and concern regarding COVID-19 is likely to vary among team members so team members should be engaged when developing any protocols related to safety.

Be prepared that perception and concern regarding COVID-19 is likely to vary among team members so team members should be engaged when developing any protocols related to safety. Also be prepared to address questions related to compensation and the use of sick leave in the event of a team member’s absence. As an employer, be familiar with ongoing legislative activities regarding your obligations to staff (as well as the economic benefits to which you are entitled). AVMA has resources that can help you at avma.org/Coronavirus.

Droplet transmission occurs when droplets created by coughing, sneezing, and vocalization are deposited on the mucous membranes. These droplets are typically large, can generally travel only approximately 1 to 2 m (3 to 6 feet), and do not remain suspended in the air.

Airborne transmission occurs when small droplets or particles that are created remain suspended in the air for extended periods and are inhaled. These small droplets or particles can be disseminated by air currents in a room or through a facility.

While it appears that SARS-CoV-2 is not easily spread from humans to animals, and there is currently no evidence to suggest that animals that may be incidentally infected by humans play a role in further human spread of COVID-19, routine infection control standards should be followed as outlined by the National Association of State Public Health Veterinarians’ (NASPHV). This is because animals are able to transmit other zoonotic pathogens.

Ensuring that your team is knowledgeable about COVID-19, its transmission, and their risk level while at work should help to alleviate some of the stress that comes with the uncertainty of how this pandemic will affect their health and job.

Elimination (physically removing the hazard) and substitution (replacing the hazard), while the most effective to prevent infectious disease transmission, are not typically options in the veterinary setting. However, engineering and administrative controls, and PPE can often be used to reduce or avoid exposures to transmissible pathogens in veterinary facilities. Effective screening and avoidance of potentially infectious persons are essential control measures to prevent unnecessary pathogen exposure.

The best way to prevent disease transmission is to use a combination of interventions from across the hierarchy of controls. This results in a greater degree of protection than a single method and provides backup in the event one control intervention fails, becomes less effective, or even unavailable.

Following are a few examples to consider when trying to maximize your staff’s safety:

Administrative Controls: Enforcing social distancing in waiting rooms; only allowing one client at a time in waiting room; keeping clients in cars until an exam room is available; taking histories from clients remotely or from the car and admitting patients directly to the hospital; not having owners assist with animal examination or restraint.

PPE: When appropriate PPE levels are adequate, utilizing face masks when social distancing between staff and clients of 6 feet is not possible. Consider using cloth face coverings at other times.

Veterinarians are viewed as leaders by our teams and our communities. It’s important to take care of your mental health as carefully as you do your physical health so you can continue to lead. It’s also important to communicate with your teams about their own mental and physical health and to provide them with resources to ensure they prioritize their own wellbeing. Find more information about what you and your teams might be experiencing and how to cope in COVID-19 and wellbeing and at avma.org/Wellbeing.

Employers should make a determination as to whether they can provide a work environment for their teams that complies with their legal obligations to protect employees from known hazards, including COVID-19.

Minimizing COVID-19 exposure flowchart

The AVMA has produced a flow chart to help you manage veterinary cases while minimizing possible exposure to COVID-19.